Delayed Diagnosis of Hip Fracture Causes Avascular Necrosis

Case Overview

This case involves the failure to diagnose a hip fracture in a 49-year-old female who had recently started running and acutely developed severe groin pain. The patient was seen only by a physician assistant who performed a basic physical exam and did not order any supporting imaging studies. The patient was advised to use heat on the afflicted area and take NSAID pain medications as needed. She was not advised to avoid weight bearing activities and no crutches were provided or recommended. The client continued to walk on her leg and two weeks later she sustained a displaced hip fracture. Due to the delay in treatment, the patient developed avascular necrosis and required a complete hip replacement.

Questions to the Internal Medicine expert and their responses

What is the standard of care in examining patients who present with acute pain radiating from the hip?

A physician must give the patient a full physical exam to rule out such causes before sending a patient home. Simply allowing a PA to see the patient and promptly discharge would be inadequate.

About the expert

This extremely well qualified internal medicine physician had over 35 years of experience working in urgent care facilities. He is board certified in emergency medicine, internal medicine, quality assurance, forensic medicine and medical examination. He is a fellow of the American Academy of Emergency Medicine, the American College of Emergency Physicians, and the American Institute for Healthcare Quality. He is a an adjunct clinical associate professor of emergency medicine.